An 86-year-old woman was admitted to a rest home for short-term
respite care while the daughter with whom she lived travelled
overseas. The woman had multi-infarct dementia and needed
assistance with mobility and personal hygiene. It was anticipated
that she would remain at the rest home for six to eight weeks; in
the event, her stay lasted 14½ weeks.

On the woman's admission to the rest home, the daughter was
supplied with, and signed, a four-page document containing
admission information. Among other things, the document advised
that residents could be attended by the home's medical practitioner
or could choose to remain under the care of their current general
practitioner. The daughter filled in the name of her mother's GP,
believing she was providing the GP's name merely as a point of
contact for the rest home's doctor, rather than opting not to use
the home's doctor. She based this on her experience the previous
year with respite care offered by another rest home. The admitting
nurse stated, however, that she would have discussed the document
with the daughter, explaining the implications of each
option.

During the woman's stay at the rest home, the home's records
reveal that she participated fully in rest home activities and by
and large displayed good health. When she contracted a urinary
tract infection, the woman's GP was contacted and prescribed an
antibiotic. Towards the end of her stay, records on four occasions
state that the woman was "very sleepy and breathless", "did not
drink and eat much" or "was not waking well".

Upon her return, the daughter thought her mother was dehydrated
and had lost weight from lack of food. The woman's son felt she had
"gone downhill rapidly". Two days after the daughter's return, and
the day before the woman's discharge, rest home records state that
the woman "refused a shower and ate very little dinner". The
following day she showered, appeared in good health, was excited to
be going home, and attended a concert before leaving the
home.

The daughter remained concerned about her mother's appearance and
arranged an appointment with her GP. Symptoms of congestive heart
failure were identified by the GP, who prescribed a mild diuretic.
The diuretic was not given to the woman until the following day and
she became "distressed and very confused". The GP admitted her to
hospital via ambulance. She was treated and transferred to a
rehabilitation ward, then discharged several weeks later.

Expert advice indicated that the woman's health did deteriorate
over the period she was at the rest home. However, many factors
could have contributed to this, including the woman missing her
daughter and the uncertainty surrounding when she would be going
home. When she did have a medical problem - the urinary tract
infection - it was detected and managed well. The woman's records
indicate that she probably developed chronic heart failure in her
last days in the rest home, and that this condition had developed
gradually. Although it is regrettable that the signs were not
picked up by the rest home staff, the signs were not easily
detectable, and the failure to refer the woman for medical
assessment was not unreasonable in the circumstances. The patient
records demonstrate that the woman's health status was carefully
observed and reported on. The rest home provided nursing care in a
manner consistent with the woman's needs and so did not breach
Right 4(3) of the Code.

It appears that the misunderstanding about who would take medical
responsibility of the woman during her stay at the rest home arose
from assumptions made from the daughter's experience with another
rest home, rather than a failure by the rest home to outline the
options for care. The rest home did not, therefore, fail in its
duty to communicate effectively. Providing residents and/or their
families with a separate information sheet that clearly explains
the home's requirements for medical oversight, and explaining the
need to elect a GP, might avoid such a misunderstanding arising in
the future.